Renal Artery Perfusion Evaluation Before Transplantation via a 3-Dimensional Image Analysis System

Abstract

Background: The perfusion areas of renal arteries in renal transplantation are assessed via subjective observations during perfusion in a bench surgery; however, this evaluation method lacks reliability and objectivity. In this study, we aimed to evaluate the perfusion area of each main and side artery kidney graft using a 3-dimensional (3D) image analysis system. Methods: We enrolled 50 patients who had undergone living kidney transplantation with multiple renal artery grafting at our center between 2005 and 2017. All computed tomography images from donors were retrospectively analyzed using a 3D image analysis system. We then calculated the artery perfusion areas associated with the artery reconstruction method used. Results: The perfusion areas of side arteries, which were evaluated after surgery, were statistically different among cases employing different reconstruction methods (P < 0.001). The perfusion area of the ligated side arteries (volume, 10 mL; proportion, 6.1%) was smaller than that of the ligated side arteries where different reconstruction methods were used. Conclusion: A 3D image analysis system could provide an accurate visual representation of the vasculature prior to living donor transplantation. It could also enable calculation of perfusion area for each artery and preoperative prediction of the need for arterial reconstruction, thereby promoting safe kidney transplantation surgery.